Bone and Joint Infections: Causes, Symptoms, and Treatment Options скачать в хорошем качестве

Bone and Joint Infections: Causes, Symptoms, and Treatment Options

Join this channel to support the channel    / @nabilebraheim   Musculoskeletal Infections: Overview and Key Points Orthopedic surgical site infections (SSI) are predominantly caused by Staphylococcus aureus. Different musculoskeletal infections are associated with specific pathogens, clinical presentations, and treatments. This overview highlights key infections and their distinguishing features. Chronic Paronychia Chronic paronychia is a fungal infection (Candida albicans) that affects the nail fold, particularly in diabetics. It does not respond to antibiotics and commonly occurs in individuals frequently exposed to water, such as bartenders or dishwashers. Unlike bacterial infections, it does not form an abscess but presents with redness, swelling, and tenderness around the nail. Multiple fingers may be involved. Treatment consists of topical antifungals, such as miconazole, while severe or resistant cases may require marsupialization. Herpetic Whitlow Herpetic whitlow is a self-limited viral infection caused by the herpes simplex virus (HSV). It is frequently observed in dentists, respiratory therapists, anesthesiologists, and toddlers. The infection presents with vesicles on the finger, accompanied by redness at the base. The vesicles contain clear fluid, and gram staining is negative. Diagnosis is confirmed using the Tzanck test, and treatment consists of Acyclovir. Surgical intervention is not required. Salmonella Osteomyelitis in Sickle Cell Disease Patients with sickle cell disease are prone to Salmonella osteomyelitis, a distinguishing feature of bone infections in this population. Pseudomonas Aeruginosa and Osteomyelitis Pseudomonas aeruginosa is frequently associated with foot punctures in children and IV drug abusers. It is the primary causative agent of osteomyelitis following nail punctures through shoes. Treatment requires incision and drainage (I&D) to remove foreign bodies, combined with appropriate antibiotic therapy. Chronic Osteomyelitis and Malignancy Risk Long-standing chronic osteomyelitis with a draining sinus over several years raises concern for squamous cell carcinoma, which must be ruled out. Osteomyelitis vs. Charcot Joint in Diabetic Patients In diabetic patients presenting with a draining sinus for months, differentiating between osteomyelitis and Charcot joint can be challenging, as both appear similar on X-ray. MRI is often unhelpful. A crucial diagnostic test is the probe-to-bone test—if the probe reaches the bone, osteomyelitis is likely, necessitating surgical debridement. Fungal Infections in Immunocompromised Patients Fungal musculoskeletal infections primarily affect elderly, malnourished individuals with chronic illness or those on long-term IV antibiotics and parenteral nutrition (PN). Erysipelas Erysipelas is caused by Group A Beta-Hemolytic Streptococcus and affects the superficial layers of the skin. It exhibits geographic demarcation, commonly appearing on the extremities or face. Treatment is with antibiotics. Necrotizing Fasciitis Necrotizing fasciitis is a rapidly progressive, polymicrobial infection, often involving Group A Streptococcus. The infection begins in the fascia, with toxins liquefying the underlying tissues. Key Clinical Features: Severe pain out of proportion to clinical findings Initially resembles cellulitis but progresses rapidly Blisters and bullae appear late Hepatitis C is a risk factor and worsens prognosis Diagnosis: If there is suspicion of necrotizing fasciitis, perform a biopsy with an incision down to the fascia. If fascia and muscle involvement is present, necrotizing fasciitis is confirmed. Treatment: Emergency aggressive debridement is required to reduce mortality, which can reach 25%. Early intervention significantly improves survival. Broad-spectrum IV antibiotics are administered after surgery. Gas Gangrene (Clostridial Myonecrosis) Gas gangrene is caused by Clostridium perfringens, an anaerobic gram-positive bacillus. It requires wide surgical debridement with the wound left open, followed by antibiotic therapy. The standard regimen includes Penicillin G and Clindamycin. Clostridium Difficile Colitis There is a distinction between Clostridium perfringens (which causes gas gangrene) and Clostridium difficile, the pathogen responsible for Clostridium difficile colitis (C. diff colitis). C. diff colitis is often triggered by antibiotics, especially Clindamycin. It presents with unexplained postoperative fever, leukocytosis, and watery diarrhea. Treatment involves oral Metronidazole (Flagyl). Human Bites and Eikenella Corrodens Human bite wounds can lead to Eikenella corrodens infection. Treatment includes Augmentin (Amoxicillin-Clavulanate). If the wound extends into a joint, surgical debridement in the operating room is necessary.